Healthcare Provider Details

I. General information

NPI: 1649432261
Provider Name (Legal Business Name): MICHAEL BENKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PROSPECT AVE
HACKENSACK NJ
07601-1960
US

IV. Provider business mailing address

25 PROSPECT AVE
HACKENSACK NJ
07601-1960
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-2277
  • Fax:
Mailing address:
  • Phone: 201-343-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA09286500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: